Child Details

Your date of birth (required):

-- Your Marital Status (required) -- Married/defacto Single Divorced/separated Widowed

Partner's date of birth:

Do you have any addictions?
Drugs   Alcohol   Cigarettes   Food   Drugs   Gambling

What Makes You Tick?

Parent's Communication Style (Modality) Assessment

Each of the numbered statements below can be completed in 4 different ways. Please choose the completion that describes you the best and give it the number 4. Then, choose the next best completion and give it a 3, and so on, giving 1 to the completion that is the least like you.

You must rate all of the completions for every numbered statement and use each of the numbers 1-4 once and only once (one 4, one 3, one 2 and one 1).

1. I make important decisions based on:

Gut feelings

What sounds best

What looks best

Precise, diligent study of the issues

2. During an argument, I am most likely to be influenced by:

The other person's tone of voice

Whether or not I can see the other person's point of view

The logic of the other person's argument

Whether or not I feel I am in touch with the other person's true feelings

3. I most easily communicate what is going on with me by:

The way I dress

My body language (hand gestures, facial expression)

The words I choose

My tone of voice

4. It is easy for me to:

Find the ideal volume and tuning on a stereo system

Select the most intellectually relevant points concerning an interesting subject

Choose superbly comfortable furniture

Select rich colour combinations

5. In regard to my awareness:

I am very attuned to the sounds in my surroundings

I am very adept at making sense of new facts and data

I am very sensitive to the way articles of clothing feel on my body

I have a strong response to colours and the way a room looks

6. In order to know someone is doing a good job, I need to:

Do the job with them, to experience some aspect of their job

Listen to a description of how they do their job

See them do their job

Get a systematic, step by step, exposure to their job and how they do it

7. I find that in class, I take most notice of information that:

I can hear, such as what the presenter is saying, sounds and noises

I can experience by doing an activity or an exercise

I can understand and fit in with other things I already know

I can see, such as PowerPoint slides, pictures or visual effects

8. In a presentation:

I take lots of notes, so I can look at them later, and I like to scribble

I remember what was said and taking notes distracts me from the speaker

I take notes and scribble, but I rarely go back to look at my notes

I take notes of my understandings, after processing what was presented

9. When reading a book:

I pay lots of attention to passages revealing feelings, moods, action and drama

I pay lots of attention to passages involving conversations, sounds and music

I pay attention to the language structure, the writing style and the plot details

I pay lots of attention to passages picturing the scenery, clothing and colours

10. In a conversation:

I explain my ideas step by step in a logical structure and progression

I need to see the other person

I use my hands and body to express myself better

I focus on what the other person is saying, even when I can't see them

11. At a party:

I like to listen to the music

I like a deep conversation I can learn from

I like to look at people's clothes, room decorations and the lighting

I like games and dancing

12. When recalling information:

I see pictures in my mind

I retrace the logic, structure or process involved

I hear sounds and words in my mind

I relive feelings and actions

13. When someone has a message for me:

I'm most comfortable when they talk to me in person

I'm most comfortable when they send me a memo

I'm most comfortable when they call me on the phone

I'm most comfortable when they say or write exactly what they mean

Child's Details

Child's Birthdate (required):

Sibling 1 Age:

Sibling 2 Age:

Sibling 3 Age:

Is your child good at sports?
Yes   No

Is your child good at arts and crafts?
Yes   No

What kind of food does your child prefer?
Sweet   Savoury

Given dessert with a meal, your child will eat it
First   Last

Your child is
Mummy's child   Daddy's child?

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